Understanding Burning Mouth Syndrome. Can it Get Better or Go Away?

 

Hi everyone

In today's episode, I’m going over the topic.....

Understanding Burning Mouth Syndrome. Can it get better or go away?

I'm Dr. Anna

and In the next few minutes you are going to learn…

about Burning Mouth Syndrome and what are the ways to identify and help manage the condition.

Head over to www.mysmilegenius.com to get the

Free Dry Mouth eBook and other resources to help you with dry mouth.

With that being said

👉👉 Do you have Burning Mouth Syndrome? Tell me about your journey and what has helped you manage the condition.

And don’t forget to like this video and share it with anyone you think can benefit from it. 

What is Burning Mouth Syndrome (BMS)?

It is a burning/tingling sensation in the mouth. Sometimes it can feel like tenderness, discomfort, as “raw” or annoying.  Usually on both sides of the tongue, mostly at the tip of the tongue, but can expand the whole length of the tongue; sometimes on the roof of the mouth (palate), lips and gums by the lower teeth.

BMS occurs is 0.6-15% of the population. Affects older individuals in age range 38-78 years. With 3:1 to 16:1 women to men ratio.  (13).

It is important to note that BMS is a condition of exclusion. Meaning that no signs of a disease (which can cause same or similar symptoms) was detected.

Authors Lamey and Lewis classified BMS:

They describe that the symptoms can come spontaneously or gradually.

Type 1 – (35%) Symptoms not present upon waking, and then increase throughout the day (Nutritional deficiencies and endocrine disorders such as diabetes)

Type 2 – (55%) Symptoms upon waking and through the day (Associated with psychological disorders, mood changes).

Type 3 – (10%) No regular pattern of symptoms (anxiety and allergic reaction)

BMS may or may not disturb sleep.

Aside from burning/tingling sensation in the mouth, how else can BMS appear?

Patients can also experience:

  • Altered sensation in the mouth - Paresthesia
  • Altered taste / metallic and or bitter taste (dysgeusia)
  • Tingling
  • Heightened taste (hyperguesia)
  • Dry mouth sensation (Xerostomia) (without actual slowing down of saliva flow).
  • Thirst.

What are some associated patient profiles/ medical conditions with BMS? (Meaning these conditions are often found in individuals that have BMS and it is very possible that they are related).

  • Postmenopausal women: it is possible it is related to an estrogen or progesterone deficit. Usually BMS occurs 3 – 12 years following menopause. (1)
  • Autoimmune disorders (such as Sjogren’s Syndrome): abnormal antinuclear antibodies and rheumatoid factor are found in the serum of more than 50% of BMS suffers. (1)
  • Depression, anxiety, traumatic psychological experiences and other psychological conditions: had been strongly associated with BMS (2)
  • Nutritional deficiencies: Iron, folic acid, Vitamin Bs or zinc (3)
  • Esophageal reflux (acid reflux).
  • Tongue trauma from long term “bad” habits (parafunctional habits) such as rubbing the tongue against the teeth. (4)
  • Patients with Parkinson’s disease.
  • Changes in oral environment and or composition or saliva which can result in neuropathy of interruption in how well nerves can interact together (5)
    • Changes in saliva are associated with
      • Aging
      • Stress (salivary cortisol level)
      • Bulimia (salivary gland swelling and reduced function
      • Diseases that can be detected in saliva (include through different markers, changes in biochemicals, DNA, RNA and proteins to the microbiota structure) Markers for diseases can be found in saliva which include: Cavities, periodontal disease, Sjogren’s Syndrome, diabetes, cardiovascular disease (including atherosclerosis, myocardial infarction and coronary heart disease), viral infections, cancers (oral, pancreatic, breast, lung, prostate), gastric ulcer and chronic gastritis. (6)
    • Patients with BMS also complain of: Headaches, TMJ pain, dizziness, musculoskeletal disorders, irritable bowel syndrome, dermatological and psychiatric disorders. (15)

Some things that make the pain worse:

  • Hot, acidic, spicy foods. Preservatives, additives, flavorings.
  • Tension, anxiety and stress
  • Fatigue (being tired)
  • Speaking

 

Conditions that can cause oral burning sensation 

  • Thrush (candidiasis)
  • GERD
  • Dry Mouth
  • Endocrine disorders such as diabetes or hypothyroidism
  • Nerve damage
  • Oral habits – tooth grinding, clenching, tongue thrusting or biting of tongue, pushing your tongue against your teeth, cheek biting
  • Allergic reaction called allergic contact stomatitis. To dental materials. (to sodium lauryl sulfate, cinnamaldehyde or dental materials) This reaction will show up as lesions in the mouth. (7)
  • Medications (scalded mouth syndrome) which are usually protease inhibitors and angiotensin-converting-enzyme inhibitors (8)
  • Bad fitting dentures
  • Geographic tongue
  • Herpetic infection (detected by presence of virus DNA in saliva.)
  • Deep grooves in the tongue (fissured tongue)
  • Lichen planus
  • HIV
  • Multiple Myleoma (9)

How to be diagnosed with BMS:

The specialists that are usually involved with BMS are Oral Medicine doctors as well as oral surgeons. Referral to medical/dental specialists. 

Patient is first tested for medical conditions that are known for causing burning in the mouth outlined above. These tests may include:

  • Bloodwork, saliva test, urinalysis for: viral/bacterial/fungal (thrush) infections, anemia, vitamin deficiencies, hypothyroidism diabetes etc.
  • Salivary flow (sialometry)
  • Allergy testing
  • Psychologic screening

 

One characteristic way in which we can tell BMS is if the pain temporarily goes away by eating and drinking, something which does not happen with neuropathy.

If no signs of disease causing these symptoms is found then the diagnosis of Burning Mouth Syndrome is made. 

What are Burning Mouth Syndrome Remedies?

Because there is no sufficient evidence of what the condition is caused by there is no cure or effective treatment.

However, there are combinations of things we can do to experience relief. 

If an underlying cause is found (which technically makes the diagnosis NOT BMS) then it is treated and or managed.

  • Medical conditions such as diabetes, hypothyroidism are managed.
  • If viral infection is involved them - Antiviral medications are prescribed. If thrush is detested, anti-fungal medications etc.

 

If no underlying medical condition is identified (true BMS) then

    • MEDICATIONS: Antidepressants, anti-anxiety, anticonvulsants are sometimes prescribed my medical doctors.
    • Alpha lipoic acid supplement has been shown in some cases to provide relief. (10)
    • VITAMIN SUPPLEMENTS including Vitamin B12, folic acid, iron, zinc, systemic capsaicin 
    • HOT SAUCE RINSE: Even though hot foods can exacerbate burning mouth syndrome, some patients find relief in rinsing with diluted hot sauce such as red chili pepper or Tabasco sauce. Start with diluting 3-5 drops of hot sauce in one tablespoon of water and rinse for 30 seconds and spit out (do not swallow). Add more water if the rinse feels too hot or more sauce if it is not strong enough. You can do this after meals and before going to bed. It may take a few days to show effects. 
    • Avoid toothpastes containing Sodium Lauryl Sulfate as it can be a tissue irritant.  

***!!! Speak to your doctor about dosages of supplements/vitamins that are appropriate for you. 

Because inflammation is associated with conditions which occur alongside BMS it is important to try to decrease inflammation in our bodies. Anti-inflammatory diet and exercise has been shown to provide many health benefits. (11). 

Also diet rich in iron, folic acid, Vitamin B and zinc. Those are the vitamins which are essential for our oral health and their deficiencies can result in oral conditions including BMS.

  • Foods rich in iron include: spinach, sprouting broccoli, lentils, dried apricot, pumpkin seeds, cashews, peas.
  • Foods rich in Vitamin B: whole grains, beans, lentils, seeds and nuts, green leafy vegetables. Fruits (citrus fruits, bananas, avocados). 
  • Foods rich in zinc: whole grains, beans, lentils, seeds, nuts, whole grains.

 Consider taking supplements if you are deficient in these vitamins/minerals. 

  • Night guard if you clench your teeth to help relieve tension in your facial musculature.
  • Relaxation techniques – to address anxiety and tension causes. Listen to music, engage in hobbies you feel passionate about and which distract you, practice, yoga, meditation, or even take time in the day to pause and take 10 deep breaths.
  • Make sure you get enough sleep. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) recommends at least 7 hours per night. Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents. (14)

Possible relieving factors

  • Avoid:
    • Hot, acidic, spicy foods
    • Stress and tension
    • The use of tobacco, alcohol or recreational drugs.
  • Distraction, engage in hobbies and activities which keep you focused on the task at hand.
  • Cold environment
  • Topical anesthetics (sometimes); but not systemic pain medications
  • discontinuation of toothpaste with whitening agents

 

Does BMS to ever go away?

For 2/3 of patients with BMS it goes away by itself after 6-7 years from starting, for others it is permanent, (12)

Head over to www.mysmilegenius.com to get the

Free Dry Mouth eBook and other resources to help you with dry mouth.

 

👉👉 Do you have Burning Mouth Syndrome? Tell me about your journey and what has helped you manage the condition.

And don’t forget to like this video and share it with anyone you think can benefit from it.

 

References:

 

  1. Brad W. Neville; Douglas D. Damm; Carl M. Allen; Jerry E. Bouquot (2002). Oral & maxillofacial pathology(2. ed.). Philadelphia: W.B. Saunders. pp. 752–753.
  2. Scully C (2013). Oral and maxillofacial medicine : the basis of diagnosis and treatment(3rd ed.). Edinburgh: Churchill Livingstone. pp. 249–253.) Sometimes it begins after a trauma or a stressful life event (Treister, Jean M. Bruch, Nathaniel S. (2010). Clinical oral medicine and pathology. New York: Humana Press. pp. 137–138.
  3. Gurvits, GE; Tan, A (Feb 7, 2013). "Burning mouth syndrome"World Journal of Gastroenterology19(5): 665–72
  4. Glick, Martin S. Greenberg, Michael (2003). Burket's oral medicine diagnosis & treatment(10th ed.). Hamilton, Ont.: BC Decker. pp. 60–61, 332–333
  5. Coulthard P; et al. (2008). Master dentistry(2nd ed.). Edinburgh: Churchill Livingstone/Elsevier. pp. 231–232.
  6. Zhang CZ, Cheng XQ, Li JY, et al. Saliva in the diagnosis of diseases. Int J Oral Sci. 2016;8(3):133–137. Published 2016 Sep 29. doi:10.1038/ijos.2016.38
  7. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. p. 63
  8. Kalantzis, Crispian Scully, Athanasios (2005). Oxford handbook of dental patient care(2nd ed.). New York: Oxford University Press. p. 302.
  9. Vučićević-Boras, V.; Alajbeg, I.; Brozovic, S.; Mravak-Stipetic, M. (2004). "Burning mouth syndrome as the initial sign of multiple myeloma". Oral Oncology Extra40: 13–15.
  10. McMillan, Roddy; Forssell, Heli; Buchanan, John Ag; Glenny, Anne-Marie; Weldon, Jo C.; Zakrzewska, Joanna M. (2016). "Interventions for treating burning mouth syndrome"The Cochrane Database of Systematic Reviews.)
  11. (Mishra A, Brinton RD. Inflammation: Bridging Age, Menopause and APOEε4 Genotype to Alzheimer's Disease. Front Aging Neurosci. 2018;10:312. Published 2018 Oct 9)
  12. Grushka, M; Epstein, JB; Gorsky, M (Feb 15, 2002). "Burning mouth syndrome". American Family Physician65(4): 615–20.
  13. Aravindhan R, Vidyalakshmi S, Kumar MS, Satheesh C, Balasubramanium AM, Prasad VS. Burning mouth syndrome: A review on its diagnostic and therapeutic approach. J Pharm Bioallied Sci. 2014;6(Suppl 1):S21–S25. doi:10.4103/0975-7406.137255
  14. Watson NF, Badr MS, Belenky G, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–844. Published 2015 Jun 1. doi:10.5665/sleep.4716
  15. Burning mouth syndrome: recognition, understanding, and management.. Klasser GD, Fischer DJ, Epstein JB Oral Maxillofac Surg Clin North Am. 2008 May; 20(2):255-71, vii

 

 

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